This document summarizes several premalignant lesions of the skin. It discusses actinic keratosis, which are rough, scaly patches that occur in sun-exposed skin and have a 20% risk of developing into squamous cell carcinoma. Cutaneous horns, keratoacanthomas, Bowen's disease, extra mammary Paget's disease, giant congenital pigmented nevi, dysplastic nevi, oral leukoplakia, and Marjolin's ulcer are also outlined. Treatment options vary depending on the specific lesion but may include photodynamic therapy, cryosurgery, topical medications, and surgical excision. Complete removal of some lesions like giant congenital pigmented nevi is difficult

1. PREMALIGNANT LESIONS OF
SKIN
Chairpersons:
Dr. S.Chakraborty
Dr. J. Podder
Speaker: Dr.Raju Mitra

2. Actinic Keratosis
• Also known as Solar Keratosis
• These are areas of dyskeratosis and cellular atypia, with subepidermal
inflammation, but a normal dermo-epidermal junction.
• Usually appear as thick , scaly or crusty area that often feel dry or
rough- may felt before they ware seen
• Lesion commonly ranges between 2-6mm in size but can grow to be a
few cm in diameter
• Use to appear on sun-exposed areas of the skin and more than one
lesion
• Diagnosis is suspected clinically and confirmed by microscopically

3. Actinic Keratosis

4. Actinic Keratosis
• Upto 20% Go on to form Squamous Cell Carcinoma
• Different therapeutic options are available
• Preventative- sunscreen and sun protective clothing
• Photodynamic therapy, freezing, tissue scraping
• Topical anti-tumor medication, NSAID
• Cryosurgery, curettage and desiccation , Laser surgery

5. Cutaneous Horn
• Cutaneous accumulation of keratin
• Hight greater than base diameter
• 10% case have underline SCC
• Excession of the lesion and biopsy
of the base to rule out malignancy
is the treatment of choice

6. Keratoacanthoma
• Cup shaped growth
• Central crater is filled with a plug of keratin
• Usually found on the face of elderly male
• Associated with papilloma virus infecting hair follicle, smoking,
carcinogen exposure
• Can grow 1 to 3 cm over 6 weeks and then typically resolve
spontaneously within 6 months
• May convert to anaplastic squamous cell carcinoma

7. Keratoacanthoma
• Removal of central keratin plug may speed resolution
• Excession is recommended

8. Bowen’s Disease
• Slowly enlarging, erythematous, scaly patch or plaque
• May occur anywhere as the mucocutaneous surface of the body
• 3-11% can progress to SSC
• On the glance penis it is called
Erythropoiesisss of Queyrat

9. Bowen’s Disease
• Management:
• Medical – 5 fluorouracil or imiquimod application
• Surgical- Excession with 4mm clear margin

10. Extra mammary Paget’s Disease
• It is a form of intra epidermal adenocarcinoma
• May occur in cutaneous site which are rich in apocrine glands such as
– axilla, genital or perianal region
• Early skin changes are subtle and may mimic an
eczematous lession
• Approximately 25% is associated with an
underlying in situ or invasive neoplasm
• Surgical excision is the treatment of choice

11. Giant Congenital Pigmented naevus

12. Giant Congenital Pigmented naevus
• It is a haematoma of naevo-melanocytes that has a tendency to
dermatomal distribution
• Naevus cells are distributed variably from the epidermis throughout
all layers and into the subdermal fat and muscle
• 3-5% lifetime risk of developing Malignant Melanoma is quoted
• Retroperitonial or intra cranial melanosis is associated with GCPN
presenting before the age of 3 or in 3rd decade
• A multidisciplinary management approach is advocated for these
birthmarks,

13. Giant Congenital Pigmented naevus
• initial investigations directed towards discovering neurocutaneous
melanosis, as leptomeningeal involvement may necessitate a shunt to
avoid raised intracranial pressure.
• Removal of GCPN can be considered for both aesthetic and
oncological reasons but the evidence to support complete excision to
avoid developing MM is poor.
• Various possibilities for partial or complete removal exist such as
perinatal curettage, dermabrasion, laser resurfacing and surgical
excision with reconstruction using a split-skin graft- none is
completely successful.

14. Dysplastic Naevi
• Dysplastic naevi are irregular proliferations of atypical melanocytes at
the basal layer of the epidermis.
• They have variegated pigmentation with irregular borders, measuring
more than 5 mm in size.
• Dysplastic naevi can have a familial
inheritance and carry a 5–10% risk of
forming superficial spreading melanoma.

15. ORAL LEUKOPLAKIA

16. ORAL LEUKOPLAKIA
• Defined as a white patch or plaque that will not rub off and that
cannot be characterized clinically or histologically as any specific
disease
• Chemical irritation through tobacco or mechanical irritation through
dental stumps or ill-fitting dentures plays a role.
• Any leukoplakia that is growing or altering its appearance requires a
repeat biopsy
• Leukoplakias on the buccal mucosa were found to be benign in 96%
of the cases; whereas on the floor of the mouth, only 32% of the
leukoplakias were benign, 31% showed a carcinoma in situ, and 37%
an invasive carcinoma

17. Marjolin's ulcer
• An aggressive ulcerating squamous cell carcinoma presenting in an
area of previously traumatized chronically inflamed, or scarred skin
• Histologically the tumour is a well-diffrentiated squamous cell
carcinoma. This carcinoma is aggressive in nature, spreads locally and
is associated with a poor prognosis
• 40% occur on the lower limb and the malignant change is usually
painless
• This malignant change of the wound happens a long time after initial
trauma, usually 10–25 years later.
• Its edge is everted and not always raised.

18. Marjolin's ulcer

19. Marjolin's ulcer
• Commonly present in the context of chronic wounds including burn
injuries , venous ulcers, ulcers from osteomyelitis and post
radiotherapy scars
• Slow growth, painlessness (as the ulcer is usually not associated with
nerve tissue), and absence of lymphatic spread due to local
destruction of lymphatic channels